Clinical and radiological characteristics of e-cigarette or vaping product use associated lung injury
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ORIGINAL ARTICLE
Clinical and radiological characteristics of e-cigarette or vaping product use associated lung injury Ambika G. Chidambaram 1 & Rebecca A. Dennis 2,3 & David M. Biko 2,3 & Marcus Hook 2 & Julian Allen 1,3 & Jordan B. Rapp 1,2,3 Received: 18 April 2020 / Accepted: 19 May 2020 # American Society of Emergency Radiology 2020
Abstract Purpose E-cigarette or vaping product use associated lung injury (EVALI) has received national attention as an epidemic resulting in cases of significant morbidity and mortality. We aim to present the clinical and imaging findings in adolescents with pulmonary symptoms from suspected EVALI. Methods Chest radiographs and CTs of adolescents (< 19 years) with acute pulmonary symptoms and history of vaping were reviewed by two radiologists in consensus. Clinical presentation and laboratory data were derived from the electronic medical records including pulmonary function tests (PFTs). Results Eleven patients were identified (9 male, mean 16.6 years). The most common presentation was progressive, subacute respiratory distress with abdominal pain. All but one of the patients tested positive for tetrahydrocannabinol. Chest radiograph features were notable for interstitial pattern of opacities (91%) and basilar abnormalities (82%). CT features were notable for ground-glass opacities (89%), interstitial opacities (78%), and subpleural sparing (67%). Eight patients underwent PFTs. Six had diffusing capacity measurement, which demonstrated impaired diffusion in 3 (50%). All patients received supportive treatment with supplemental oxygen and corticosteroids. Conclusion Adolescents with suspected EVALI commonly present with subacute respiratory distress with abdominal pain. Imaging findings include ground-glass opacities, subpleural sparing, and basilar opacities, most consistent with organizing pneumonia or hypersensitivity pneumonitis. Recognition of the common imaging findings may have significant patient management implications, especially if the diagnosis is not suspected clinically. The lung function effects of vaping are consistent with mildly reduced airflow, which improves on follow-up testing, and reduced diffusion capacity, which, concerningly, does not improve. Keywords EVALI . Chest . Adolescents . PFTs
Introduction Meetings This paper was accepted for presentation at the Society of Pediatric Radiology (SPR) 2020 in Miami, FL originally scheduled for May 12th 2020. * Jordan B. Rapp [email protected] 1
Department of Pulmonology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
2
Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, 3NW40, Philadelphia, PA 19104, USA
3
University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
Lung injury related to the use of electronic nicotine and marijuana delivery devices recently and markedly spiked over the several months in late 2019. Per the CDC morbidity and mortality publication as of February 2020, there have been over 2800 reported cases of hospitalized e-
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